Capitol Hill Report: Health Care Reform - Focusing on the Patient

July 6, 2009

The mission of the Academy is to be "indispensable to its members." One way the Academy fulfills this mission is by representing of neurology in the halls of Congress. Capitol Hill Report presents regular updates on legislative action and how the AAN ensures that the voice of neurology is heard on Capitol Hill. The Academy's legislative counsel in Washington, DC, Mike Amery, offers weekly updates on advocacy for neurology and neurologic concerns.

Congress was in recess last week, but the health care train continues to move forward. As reported last week, the Academy commented on the House Tri-Committee draft bill. A big part of the Academy's comments is a proposal to reform the physician payment system to focus on patients by paying bonuses to physicians who coordinate the care of Medicare beneficiaries who are eligible for Special Needs Plans. The bonus would apply only to evaluation and management services and would lead to a more level playing field for physicians who provide cognitive care.

This letter is the basis for the Academy's lobbying efforts to ensure that cognitive specialties are included in efforts to improve payment for Primary Care physicians. With most members of Congress back in their home districts because of the recess, I had several meetings to push this plan with staff including with the Senate Finance Committee majority and minority staff and several meetings with staff of House Energy & Commerce Health Subcommittee. I have been joined on the Hill by representatives of the American Society of Hematology and the Epilepsy Foundation. The idea is being greeted as something new and hopefully we will find Congress interested in moving the discussion to the needs of the patient.

In other news this week, Senate Finance Chair Max Baucus (D-Mont.) said his panel has trimmed the cost of its health reform bill to less than $1 trillion over 10 years. As I mentioned last week, an earlier Congressional Budget Office score put the price tag at $1.6 trillion. Although he did not discuss the details of the plan, Baucus said the committee discussed the idea of giving more power to the Medicare Payment Advisory Commission (MedPAC) so that MedPAC can make more appropriate decisions on providers' reimbursement, and give Congress a way to approve without amendment, the recommendation of MedPAC. This follows a bill (S 1110) that has been introduced by Sen. Jay Rockefeller (D-W.Va.) that would make MedPAC an executive level branch that could make changes to Medicare, as a means of removing the influence of special interests that can affect Congress' action on such matters. In a June 2 open letter to Senators Kennedy and Baucus, President Obama endorsed the idea as a "valuable tool to help achieve health care reform in a fiscally responsible way."

Former MedPAC Vice Chair Robert Reischauer doubts that giving MedPAC authority to implement changes to the Medicare system will help. Currently, MedPac only recommends policy. According to Reischauer, it would be preferable to have such decisions made from a body free of political pressures, and warned that tensions would be inevitable once decision-making authority is given to a single organization.

Lastly, the Centers for Medicare & Medicaid Services CMS said that it plans to cut Medicare payments for imaging services and specialists, and increase payments to primary care physicians. The agency also proposed a regulation that would remove costs for physician-administered drugs from Medicare spending targets used to determine payment levels. The outlay proposal would have no effect on the scheduled 21.5 percent payment reduction that physicians face next year. CMS said in a release that the plan "would reduce the number of years in which physicians are projected to experience a negative update." The American Medical Association said the proposal "clears the way to permanent physician payment reform." Removing drugs from the formula is something that the Academy has advocated for several years.